Borderline Personality Disorder (BPD) is a challenging mental health condition that is characterized by a collection of symptoms, including emotional dysregulation, fear of abandonment, self-harm, impulsivity, unstable moods, unstable relationships, and an unstable self-image. Stereotypical symptoms include suicidality and self-mutilation, although the clinical presentation of BPD varies widely across all individuals.
According to research, BPD affects around one to two percent of the adult population, however, it is thought to be underdiagnosed, especially in men. (Leichsenring, et al., 2024) Part of the reason for this is that BPD is often misunderstood and frequently misdiagnosed, or it is conflated and confused with other mental health conditions.
“Borderline”
The disorder was first identified by psychoanalyst Adolph Stern in 1938, who used the term “borderline” to describe patients who were “on the border” of psychosis and neurosis (Stern, 1938). For decades, these people were classified as “borderline schizophrenic” or “borderline neurotic.” In 1975, John Gunderson defined and re-named the disorder to the name we’re familiar with today (Gunderson and Singer, 1975). It wasn’t until 1980 that BPD was formally recognized as a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Nowadays, it is sometimes called emotionally unstable personality disorder (EUPD).
However, these various labels have often been misleading. “Borderline schizophrenic” was a misnomer, because BPD and schizophrenia are distinct mental health conditions. Its current name, however, associates the condition with more serious personality disorders. As a result, BPD is often stigmatized and lumped in with narcissism, sociopathy, and psychopathy. (The latter two are technically called antisocial personality disorders or ASPD.) In light of these misclassifications of BPD, some prefer to call it emotional intensity disorder (EID) to better reflect the nature of the condition and differentiate it from others.
Distinguishing BPD from other conditions
BPD is often conflated with other mental health conditions (Saunders, et al., 2015). Part of the reason for this is that it has some overlap with other disorders. For instance, BPD commonly includes post-traumatic stress disorder (PTSD), depression, and anxiety, although being diagnosed with these alone can mask the bigger issue. BPD is also frequently misdiagnosed. In particular, it is misdiagnosed as schizophrenia. While both have delusions in common, there are considerable differences between the two, notably the auditory and visual hallucinations that characterize the latter.
BPD is also commonly conflated with bipolar disorder (BD). The two have similar names, which may cause some confusion. They also share the symptoms of reckless behaviors and mood swings, although BD is characterized by alternating episodes of mania and depression. BPD is also confused with other disorders, such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and other personality disorders. BPD can also share symptoms with these conditions or be comorbid with them. In particular, addictions and eating disorders co-occur with BPD. It can be difficult to tease apart these similar conditions.
The similarities to other conditions and the general confusion around BPD add to the misconception that it is untreatable. While there is no cure for the condition, it can be successfully managed, usually with medication in conjunction with therapy. In particular, evidence-based dialectical behavior therapy (DBT) has proven to be successful for those with BPD.
The takeaway message is that BPD is a misunderstood and often misdiagnosed condition. For these reasons, it is vital to seek out an evaluation from a qualified therapist so that individuals receive an accurate diagnosis and appropriate treatment.
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